DESCRIPTION: The increase in competition during the last decade raises concerns among patients, physicians, payers, and policy makers that the quality of medical care might be compromised. To improve information about quality in the health care system, employers and governments are developing report cards. These are intended to assist payers and patients to balance costs and quality. However, there is very little known about the use and effectiveness of such reports in influencing decisions made by patients, referring physicians, and managed care organizations. This study is designed to evaluate the effects of a New York State cardiac surgery report. This report card includes risk-adjusted mortality rates for all hospitals and surgeons performing CABG operations in New York State. This study will evaluate the impact of this report card on choice of hospitals and cardiac surgeons by patients, their physicians, and managed care organizations. It will identify factors contributing to its effectiveness. The study will analyze and compare the use of the NYS report card in the fee-for-service environment and by managed care organizations (MCOs). Data from several sources, including a unique data base with information about contracting arrangements among all HMOs in New York State, all cardiac surgeons, and all hospitals will be used to study contracting practices of MCOs. Statistical regression techniques will be used to determine factors such as the effect of risk-adjusted mortality rates on the probability of a contract between an MCO and a surgeon and the influence of factors such as competition, HMO penetration and socio-demographic characteristics of each market. Choices of hospitals and cardiac surgeons made by patients enrolled in fee-for-service plans will be analyzed using Medicare fee-for-service claims. These data will be used to identify referral decisions and to create variables that characterize surgeons, patients, and their referring physicians. Statistical regression techniques will be used to identify factors that enhance or impede the effectiveness of the NYS report on the choice of a surgeon. The effectiveness of the report in fee-for-service and managed care environments will be assessed. The study will provide empirical information on the effectiveness of the New York State cardiac surgery reports on influencing decision making by several major players in the health care system and will increase understanding of factors likely to enhance their effectiveness.